CHILDHOOD OBESITY

1. CHILDHOOD OBESITY Kara Elkins, Kelli Erb, Marisa Gariglio, and Ashley Westrate

2. US STATISTICS • Child obesity has more than tripled over the last 30 years • Approximately 17% of children (12.5 million) , ages 2-19 are obese in the US. • This chart below shows the percentage of high school students that were obese in 2011 in the US. CDC, 2012

3. MICHIGAN STATISTICS • One in four adolescents is overweight • 18.2% of Michigan youth, ages 10-17 years old are overweight • 12.4% of Michigan youth are considered obese (Healthy kids, Healthy Michigan) • 14.2% of Michigan adolescents are overweight • 11.9% of adolescents were considered obese • 16.3% of children ages 2-5 were overweight • 13.3% of children ages 2-5 were considered obese (CDC)

4. KENT COUNTY STATISTICS • 6.1% of Michigan’s population lives in Kent County • Of that percent, 10.5% of Kent County’s youth is obese • www.kentcountychna.org/pdfs/KentCoCHNA_Final.pdf

5. Problem Statement Increase Prevalence of (not sure what to put here) among school age children 5-19 in Kent County, Michigan Related To: overweight and obesity in children As Evidenced By: (Something here)

6. Disciplines involved • Other disciplines that should be involved with fighting obesity in the youth of Kent County are: • Teachers • Doctors (primary care and specialists including psychologists) • Parents • Nutritionists • Administrators • Policy makers

7. Health Belief Model • The health belief model proposes that a person's health-related behavior depends on the person's perception of four critical areas: • the severity of a potential illness, • the person's susceptibility to that illness, • the benefits of taking a preventive action, and • the barriers to taking that action. • HBM is a popular model applied in nursing, especially in issues focusing on patient compliance and preventive health care practices. Most children do not understand the consequences and health risks of being obese. The Health Beliefs Model (HBM) will only work after the children are properly educated on the risk factors of being obese. Then they will decide for themselves how much a lifestyle change is worth to them and their health. Nursing Theories, 2012

8. There are six major concepts in HBM: • Perceived Susceptibility: refers to a person’s perception that a health problem is personally relevant or that a diagnosis of illness is accurate. • Perceived severity: even when one recognizes personal susceptibility, action will not occur unless the individual perceives the severity to be high enough to have serious organic or social complications. • Perceived benefits: refers to the patient’s belief that a given treatment will cure the illness or help to prevent it. • Perceived Costs: refers to the complexity, duration, and accessibility and accessibility of the treatment. • Motivation: includes the desire to comply with a treatment and the belief that people should do what. • Modifying factors: include personality, variables, patient satisfaction, and socio-demographic factors. • (Nursing Theories, 2012).

9. MICHIGAN SCHOOLS State Requirements What the state doesn’t require Nutritional standards for foods served outside of school meals (vending machines, school functions, or any competitive foods) Policies to require BMI collection Nutritional standards that are stricter than the US Dept. of Agriculture standards. • Physical Education policies • Health Education requirements • Education policy action team (EPAT) • Advocates for legislation that will ensure that all of Michigan schools provide students with a quality education in health and physical education, in an environment where healthy foods are offered • Health, family, and childcare services policy action team (HPAT) • Working on developing a statewide system to monitor BMI • Community policy action team • Policy change that work for safe environments to promote physical activity (Healthy Kids, Healthy Michigan) • (Healthy Kids, Healthy Michigan, 2012)

10. Physical EducationRequirements • Taught by a certified physical education teacher • Keeps all students involved in all activities • Includes all students of all abilities and skill level • Elementary- 150 minutes a week/Middle and High schools 225 minutes a week of instruction. • Maintains and has functional equipment for each student “Physical education programs provide students with knowledge, skills, fitness, and attitudes necessary to lead a healthy lifestyle” (Michigan Dept. of Education, 2012)

11. Health Education Requirements • Each school must have a research-based, theory driven comprehensive health education program that provides at least 50 hours of health education at every grade, pre-K through 12. • This programs aims to teach kids how to eat healthy and make healthy choices including not smoking, drinking, or doing drugs. (NASBE, 2011)

12. Kent County Health Department Nutrition Education for School Aged Children • Elementary 1st-6th Grades: Lessons include age appropriate nutrition concepts and fun activities, handouts for students and information to send home to parents. • Middle/High School: One hour presentation topics: • Food and Disease • Physical Activity and Your Health • Nutrition and the Media • Label Reading • Fast Food Facts • Body Image http://www.accesskent.com/Health/HealthDepartment/Health_Promotion/School_Wellness.htm

13. Statewide projects • Healthy Kids, Healthy Michigan • Michigan Action for Healthy Kids (MAFHK)

14. Action For Healthy Kids (AFHK) • Action for Healthy Kids is the nation’s leading non-profit and largest volunteer network fighting childhood obesity and undernourishment by partnering with schools to improve nutrition and physical activity to help our kids learn to eat right, be active every day, and be ready to learn. • Michigan Action for Healthy Kids (MAFHK) is a state coalition of more than 1800 health and nutrition professionals, parents, students, physicians, business leaders, and other community members who take action in their schools, communities, and regions to make positive change. As the largest Action for Healthy Kids Team in the country, Michigan has a strong voice at the state and national level. http://www.actionforhealthykids.org • “Every Kid Healthy Pledge” program: Working together to keep kids healthy and ready to learn • “Get In the Action” program: Volunteers can help schools with planting a garden, build an indoor fitness center, renovate jungle gyms, assist with fresh fruit in the cafeteria, fresh fruit and vegetable taste testing, and “brain breaks” with spurts of physical activity. • http://www.accesskent.com/Health/HealthDepartment/Health_Promotion/School_Wellness.htm

15. ReCharge! Energizing After-School An after-school program designed to help students in grades 2 to 6 learn about and practice good nutrition and physical activity habits through fun, team-based strategies.  Works in collaboration with the National Football League and addresses national educationstandards and is designed to be practical, feasible and adaptable to a variety of settings and program types.  It focuses on four core concepts: Energy in (nutrition) Energy out (physical activity) Teamwork Goal setting http://www.actionforhealthykids.org/recharge/about/

16. Kent County Projects • FIT initiative • Funded by Blue Cross Blue Shield • Coordinates with community organizations to increase access to safe and affordable physical actives, improve the affordability and availability of nutritious food, and increase knowledge, attitudes, and behaviors associated with healthy living (Michigan State University) • Kent County Coordinated School Health Program (KCCSHP) • Nutrition Education for School Age Children • Healthy School Action Tools (HSAT)

17. What Kent County Offers • FIT Program - $1 million program initiated at 4 Grand Rapids schools. 1,000 students are taking part. - Includes healthy eating coaches to encourage healthy choices, and 30 minutes a day of exercise. -Program is for children at or above 95th percentile for weight and are referred by physicians. - Program hopes to grow to help more that 350 children per year. (Hamilton, 2010)

18. Community Services Kent County Coordinated School Health Program (KCCSHP) The Kent County Health Department is one of the community agencies working together to support schools in their mission to promote healthy behaviors of students and create a healthy, positive learning environment Sends trained facilitators to lead school staff through the Healthy School Action Tool (HSAT), a free, online tool (www.mihealthtools.org) which helps schools assess their nutrition and physical activity Supplies access to local community resources to help schools implement their action plan Giving three years of direct support for action planning, implementation, and evaluation Providing up to date resources to develop sustainable and measurable environmental changes in their school building that offer consistent messages about the importance of healthy eating and physical activity. http://www.accesskent.com/Health/HealthDepartment/Health_Promotion/School_Wellness.htm

19. Kent County Events • 2012 Race for Healthy Kids on October 7, 2012 in Rockford • Rockford High School • 4100 Kroes Street NE • Rockford, MI 49341 • 5K Run/Walk 2:00 pm • Kids Fun Run 3:30 pm • Girls on the Run • “Girls on the run is a nonprofit program designed to help pre-teen girls build confidence, strengthen their self image and develop healthy life skills. This program combines training for a 5K (3.1 mile) run/walk with a series of engaging, fun lessons that inspire girls to make a difference in their own lives and in the lives of others.” • (Kent County Girls on the Run, 2012).

20. Kent County Community Activities • YMCA of Grand Rapids, www.grymca.org • Gymco Sports, www.gymco.com • For the Kidz Gymnastics, www.forthekidz.com • Kentwood Fun Spot, www.kentwoodfunspot.com • Cannonsburg Ski Area, www.cannonsburg.com • Rockford Area Parks, www.therockfordnetwork.com/areaparks • John Ball Park Zoo and Junior Zookeepers Program, http://www.accesskent.com/CultureLeisureAndTransit/Zoo/zoo_index.htm • Disc Golf, http://www.accesskent.com/CultureLeisureAndTransit/Parks/events.htm • Gerald R. Ford Museum, http://www.fordlibrarymuseum.gov/

21. Family/Parents • Encourage participation in community events • Exercise and participate in fun “active” activities with your child • Model healthy eating behaviors • Teach children basic nutrition and explain why it is important • Education on all healthy behaviors

22. Role of a School Nurse • During the school year most children ages 6-18 spend the majority of their time in school. • “Most of the work school nurses do focuses on direct care for acute conditions, but they also perform health screenings such as vision, hearing, and blood pressure screening, in addition to screening for overweight and obese children” (Schantz, 2011). • Benefits of Being a School Nurse • Ability to build a rapport with the students, so that students will trust the nurse with health related concerns. • Knowledge of community programs and policies to assist in weight loss or prevention of obesity • Respected by staff, students, and parents as a professional nurse

23. Other Resources • Center for Disease Control • Access Kent • Michigan Department of Community Healthy

24. With so many resources, why is childhood obesity still a problem? • “19,172 residents in Kent County live in a “food desert”, meaning they do not have access to a grocery store, and there are 17,920 residents who have limited access to grocery stores in their neighborhoods” • 89% of people in Kent County have access to healthy food compared to 73% overall in Michigan • Kent County experienced a -2.1% drop in fast-food restaurants (Michigan public health institute)

25. Why is there still a problem? Continued… • Lack of healthy food resources in some communities • Dependence on corner stores that may not carry healthy foods • Expense of healthy eating • Not all districts in Kent County are making healthy food available yet • School vending machines that stock unhealthy food and drinks • Convenience and affordability of eating at fast food chains (Michigan public health institute)

26. Why is this problem appropriate for community nursing interventions? • Community assessments • Identifying risks and health needs in community • Nurses as resources • Advocate • Multidisciplinary team member

27. Evaluation • Kent Steps Up is a program designed to encourage elementary aged children increase physical activity and to take 10,000 steps per day. They monitor their progress with a program provided pedometer. • (http://www.healthykent.org/kentstepsup/)

28. Kent Steps Up • This program helped teach participating students that “movement is physical activity” and the hope is the children will continue physical activity. • (http://www.healthykent.org/kentstepsup/)

29. Evaluation- Action for Healthy Kids • “During 2008-2009 Action for Healthy Kids reached nearly 4 million kids in 8,000 schools in 1100 school districts. • Action for Healthy Kids is looking ahead: “2008-2012 Action for Healthy Kids intends to support 10 million kids in 25,000 schools and 4,500 school districts. That’s nearly 1 out of 5 schools!” http://www.actionforhealthykids.org/who-we-are/our-approach/

30. Evaluation-FIT initiative • MSU and Blue Cross Blue Shield are working toward the FIT initiative. • This program is hoping to achieve reduced student absenteeism and increase student achievement. http://news.msu.edu/story/6655/

31. References • Action for Healthy Kids. (2011). Michigan Action for Healthy Kids. Retrieved from: www.actionforhealthykids.org. • Action for Healthy Kids. (2012) Retrieved from: http://www.actionforhealthykids.org/for-schools/wellness-policy-tool/ • Action for Healthy Kids. (2012). ReCharge. Retrieved from: http://www.actionforhealthykids.org/recharge/about/ • Hamilton, T. (2010, February 23). New Efforts Take Aim at Fighting Childhood Obesity in Michigan. Retrieved from: www.mlive.com/news/grand-rapids/index.ssf/2010/02. • Healthy kids, Healthy Michigan (n.d.) Healthy kids, healthy Michigan. Retrieved from http://www.healthykidshealthymich.com/ • Healthy Kids, Healthy Michigan. (2012). Statewide Scan of Childhood Obesity Programs, Policies, and Resources in Michigan. Retrieved from: http://www.michigan.gov/documents/mdch/EnvironmentalScanExecutiveSummaryReduced_244924_7.pdf. • Kent County Girls on the Run. (2012). Retrieved from: http://kcgotr.org/. • Kent County Health Department. (2012). Health education and promotion: School wellness. [Brochure]. Retrieved from: http://www.accesskent.com/Health/HealthDepartment/Health_Promotion/School_Wellness.htm • Michigan Department of Education. (2012). Physical Education. Retrieved from http://michigan.gov/documents/mde/NewMMCPE9-5-2007_213954_7.pdf. • Michigan public health institute (2011). 2011 Community health needs assessment and health profile. Retrieved from www.kentcountychna.org/pdfs/KentCoCHNA_Final.pdf • Michigan State University (2009). MSU lands $1 million grant to tackle childhood obesity in West Michigan. Retrieved from http://news.msu.edu/story/6655/ • National Association of State Boards of Education (2011, August 14). State School Healthy Policy Database. Retrieved from: www.nasbe.org/healthy_schools/ns/bytopics. • Nursing Theories. (2012, January 31). Health Belief Model. Retrieved from: http://currentnursing.com/nursing_theory/health_belief_model.html.

32. REFERENCES • State of Michigan: Department of Education. (2009, July 27). Michigan Nutrition Standards. Retrieved from: www.michigan.gov/documents/mde/mi_nutrition_standards.